Abstract
Purpose
To determine the prevalence and natural history of nmCRPC prior to the adoption of
novel androgen receptor axis-targeting therapies(ARAT).
Materials and Methods
This was a retrospective population-based cohort study of men with nmCRPC in Ontario,
Canada between January 2007-March 2018. Patients with prostate cancer, castrate level
of testosterone(<1.7nmol/L) and a PSA>2.0ng/mL with a subsequent rise>25% from the
nadir, and without metastasis were included. Annual prevalence of nmCRPC was calculated.
Crude time from nmCRPC to metastasis and all-cause death are presented as medians
with interquartile range(IQR). Predictors of time from nmCRPC to death were compared
using univariable and multivariable cox proportional hazard models.
Results
We identified 2045 patients with nmCRPC. Median age was 79(IQR:72-84). 984 patients(48.1%)
received upfront hormonal therapy while 583(28.5%) received initial radiotherapy and
478(23.4%) underwent radical prostatectomy. Median time from primary treatment to
nmCRPC was 6 years(IQR:3-10). The average annual prevalence of nmCRPC was 8% among
men receiving ADT. Crude median time from nmCRPC to death was 37.6 months(IQR:22.1-55.4).
Median time from nmCRPC to metastasis and metastasis to death was 20.0 and 8.3 months,
respectively. Patients who had primary surgery experienced longer crude survival.
Older patients, patients who had a higher PSA at nmCRPC, and patients with grade group
4 to 5 disease had a shorter time from nmCRPC to death.
Conclusion
This is the largest population-level analysis of the prevalence and natural history
of nmCRPC. The current study can be used as a historical cohort to compare how novel
imaging modalities and ARAT impact prevalence and disease trajectory over time.
Keywords
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References
ACS. American Cancer Society: Key Statistics for Prostate Cancer. Accessed January, 2020. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html.
- Changing incidence of metastatic prostate cancer by race and age, 1988-2015.Eur Urol Focus. 2019; 5: 1014
- Trial design and objectives for castration-resistant prostate cancer: updated recommendations from the prostate cancer clinical trials working group 3.J Clin Oncol. 2016; 34: 1402
- Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer.N Engl J Med. 2018; 378: 1408
- Enzalutamide in men with nonmetastatic, castration-resistant prostate cancer.N Engl J Med. 2018; 378: 2465
- Darolutamide in nonmetastatic, castration-resistant prostate cancer.N Engl J Med. 2019; 380: 1235
- Novel nonsteroidal antiandrogens and overall survival in nonmetastatic castration-resistant prostate cancer.Eur Urol. 2018; 74: 534
- The IMAAGEN study: effect of abiraterone acetate and prednisone on prostate specific antigen and radiographic disease progression in patients with nonmetastatic castration resistant prostate cancer.J Urol. 2018; 200: 344
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.BMJ. 2007; 335: 806
- An application of capture-recapture methods to the estimation of completeness of cancer registration.J Clin Epidemiol. 1988; 41: 495
- EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer.Eur Urol. 2017; 71: 630
- Population-based analysis of treatment toxicity among men with castration-resistant prostate cancer: a phase IV study.Urology. 2018; 113: 138
- Natural history of progression after PSA elevation following radical prostatectomy.JAMA. 1999; 281: 1591
- Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?.BJU Int. 2011; 108: 1588
- Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer.J Clin Oncol. 2005; 23: 2918
- Assessing the generalizability of randomized trial results to target populations.Prev Sci. 2015; 16: 475
- The "Efficacy-Effectiveness Gap": historical background and current conceptualization.Value Health. 2016; 19: 75
- Treatment and trials in non-metastatic castration-resistant prostate cancer.Nat Rev Urol. 2021; 18: 433
- Characterising the castration-resistant prostate cancer population: a systematic review.Int J Clin Pract. 2011; 65: 1180
- Predictors of survival, healthcare resource utilization, and healthcare costs in veterans with non-metastatic castration-resistant prostate cancer.Urol Oncol. 2020; 38: e13-930.e21
- Castration-resistant prostate cancer: AUA guideline amendment 2018.J Urol. 2018; 200: 1264
- Thresholds for PSA doubling time in men with non-metastatic castration-resistant prostate cancer.BJU Int. 2017; 120: E80
- Impact of age, comorbidity, and PSA doubling time on long-term competing risks for mortality among men with non-metastatic castration-resistant prostate cancer.Prostate Cancer Prostatic Dis. 2019; 22: 252
Article info
Publication history
Published online: October 12, 2022
Accepted:
October 4,
2022
Received in revised form:
October 3,
2022
Received:
June 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
